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Ortho Infections Flashcards

1
Q

Why is staph aureus having an increased resistance to antibiotics?

A

Plasmids

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2
Q

When do bacteria enter the body?

A

Altered hemostasis

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3
Q

In regards to blood supply, when does the risk of infection increase?

A

Decreased blood supply

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4
Q

What increases microcirculation & vasodilation?

A

Warming of the source of infection

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5
Q

How does a traumatic injury & the presence of implants increase the risk of infection?

A

Periosteal injury, micro/macrovascular compromise
Bacteria have affinity for exposed sites
Form glycocalyx capsule
Impair normal immune function & abx penetration

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6
Q

Factors that Decrease Local Immune Responses

A

Decreased blood flow
Neuropathy
Trauma
Medication

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7
Q

Medications that can Decrease the Local Immune Response

A

NSAIDs
Rheum
Steroids

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8
Q

Factors that Decrease the Systemic Immune Response

A 
Renal & liver disease
DM
ETOH
Rheum diseases
Immunocompromised state
Malnutrition
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9
Q

Diagnostic Test with Musculoskeletal Infections

A

H&P
Labs
Culture of fluid or tissue

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10
Q

Presentation of a Musculoskeletal Infection

A 
Pain
Warmth
Swelling
Redness
Refusal to bear weight (esp. children)
Fever/chills
Night sweats
N/V
Loss of joint motion
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11
Q

Labs to Diagnose Musculoskeletal Infections

A 
CBC with differential
ESR
CRP
Blood cultures
Gram stain
Frozen section
PCR: polymerase chain reaction
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12
Q

When does ESR elevate in infection?

A

Within 2 days of infection

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13
Q

When does CRP elevate, peak, and return to normal in an infection?

A

E: within 6 hours
P: 48 hours
Return: 1 week after appropriate treatment

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14
Q

What is the best indicator for diagnosis & monitoring treatment of an infection?

A

CRP

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15
Q

What diagnostic modality has shown to be helpful in peri-prosthetic infections?

A

IL-6

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16
Q

Things you can see on Plain Films for Musculoskeletal Infections

A

Soft tissue swelling
Loss of tissue planes
Bony changes (40+% loos to see)
Brodies Abscess

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17
Q

Other Radiologic Tests to Detect Musculoskeletal Infections

A 
Bone scan: vague
Indium 111 leukocyte nuclear scan
Gallium citrate scan
PET scan
MRI
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18
Q

What diagnostic modality is used frequently for infection?

A

MRI

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19
Q

When do musculoskeletal infections frequently happen?

A

Open fractures
DM
Recent surgery

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20
Q

Describe Hematogenous Osteomyelitis

A

Osteomyelitis which was transferred by the blood

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21
Q

Desccribe Contiguous Focus Osteomyelitis

A

Infection caused by a prior infection

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22
Q

Classification of Musculoskeletal Infections that Describes the Anatomic Involvement

A

Stage 1: medullary
Stage 2: superficial
Stage 3: localized
Stage 4: diffuse

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23
Q

Classification of Musculoskeletal Infections that Describes the Host

A

Normal
Compromised
Treatment worse than disease

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24
Q

Most Common Sites of Hematogenous Osteomyelitis

A

Vertebrae***
Long bones
Pelvis
Clavicle

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25
Vertebral Osteomyelitis
50+ | May involve 2 vertebrae + disc
26
Most Common Bug with Hematogenous Osteomyelitis
S. aureus
27
Most Common Bugs in Vertebral Osteomyelitis
S. aureus | Pseudomonas (IVDU)
28
Presentation of Vertebral Osteomyelitis
Fever Pain over area Possible: meningitis, abscesses
29
Most Common Reasons for Contiguous-Focus Osteomyelitis without General Vascular Insufficiency
``` Trauma with direct contact to bone Infection from soft tissue Nosocomial infection ORIF Prosthetics Open fractures Chronic soft tissue infections ```
30
When does a continguous-focused osteomyelitis without general vascular insufficiency occur?
About 1 month after primary cause of infection
31
Presentation & Sequelae of Contiguous-Focus Osteomyelitis without General Vascular Insufficiency
P: pain, fever, drainage of area S: decreased bone stability, necrosis, & soft tissue damage
32
Most Common Bugs with Contiguous-Focus Osteomyelitis with General Vascular Insufficiency
Staph Strep Enterococcus G-bacilli
33
Presentation of Contiguous-Focus Osteomyelitis with General Vascular Insufficiency
Ulcers Multiple foot problems DM
34
Chronic OSteomyelitis
H/O osteomyelitis Recurrence of pain, fever, drainage, erythema, & swelling Nidus of infection must be removed Prolonged can develop SCC or amyloidosis
35
Diagnosis of Musculoskeletal Infections in Adults
H&P Labs Imaging Osteomyelitis: great mimicker
36
Treatment of Musculoskeletal Infections in Adults
Antibiotics: 4-6 weeks Adequate drainage, debridement, dead space management, maintenance of blood supply/wound care Treat systemic issues
37
Treatment of Musculoskeletal Infections in Adults from Last Debridement
Stage 1: medullary (4 weeks antibiotics) Stage 2: superficial (2 weeks antibiotics) Stage 3: localized (4-6 weeks antibiotics) Stage 4: diffuse (4-6 weeks antibiotics)
38
Treatment of Musculoskeletal Infections in Adults When Surgery is not an Option
Rifampin + fluoroquinolone or Bactrim for 6 months | Possible long term suppression
39
Surgical Debridement of Musculoskeletal Infections
Complete when bone bleeds "paprika sign" Dead = remove FB = remove Bony defects: autograft or ex. fix
40
Alternative Treatment of Musculoskeletal Infections in Adults
Antibiotic impregnated beads: high concentrations of antibiotics & fills dead space Antibiotic pumps
41
Can fractures heal in the setting of infection?
Yes Stable better than unstable Int./Ex. fixation
42
Types of Coverage of Soft Tissue Injuries
Wound pumps Flaps Skin grafts Avoid secondary intention
43
Hyperbaric Oxygen Therapy for Musculoskeletal Infections in Adults
Useful for chronic osteomyelitis & soft tissue injuries
44
Benefits of Hyperbaric Oxygen Therapy in Musculoskeletal Infections in Adults
Promotes collagen formation & angiogenesis | Increases oxygen tension in soft tissues
45
Cons to Hyperbaric Oxygen Therapy in Musculoskeletal Infections in Adults
Expensive | Multiple sessions
46
Possible Routes of Adult Septic Osteoarthritis
Blood Trauma Contiguous spread IVDU
47
Predisposing Factors for Adult Septic Arthritis
``` DM Rheum Steroid use HIV Malignancy Age ```
48
Most Common Joint Affected from Adult Septic Arthritis
Knee
49
Pathophysiology of Adult Septic Arthritis
Destruction of synovial cell lining Glycosaminoglycan destruction Increase inflammatory response Destruction of cartilage
50
Most Common Organisms for Adult Septic Arthritis
``` N. gonorrhea S. aureus (IVDU) E. coli Pseudomonas Fungal (HIV) ```
51
Presentation of Adult Septic Arthritis
Warm, swollen, & painful joint
52
Infectious Blood Work for Adult Septic Arthritis
CBC ESR CRP
53
What are we looking for when we send an aspiration sample?
Cell count with differential Crystals Gram stain Cultures
54
Treatment of Adult Septic Arthritis
Surgery Immediate antibiotics Arthrotomy & debridement NSAIDs: decreases cartilage damage
55
Most Common Location of Musculoskeletal Infections in Pediatric Patients
High vascular areas at the metaphysical epiphyseal are
56
Most Common Organisms for Pediatric Musculoskeletal Infections
``` S. aureus Group A strep H. influenza Kingella kingae (URI presentation) Salmonella (sickle cell) Bartonella henselae (cat scratch disease) P. aeruginosa (feet) ```
57
Pathophysiology of Osteomyelitis in Neonates
Infection perforates periosteum | Spreads to surrounding tissue & joints
58
Pathophysiology of Osteomyelitis in Infants
More rare due to metaphyseal capillary atrophy
59
How is osteomyelitis spread limited in children?
Thickening of the cortex of bones
60
Diagnosing Musculoskeletal Infections in Pediatrics
Fever + limb pain for 3+ days needs evaluation
61
Presentation of Musculoskeletal Infections in Neonates
Pseudoparalysis Pain with palpation Swelling Decreased appetite
62
Presentation of Musculoskeletal Infections in Infants, Toddlers, & Young Children
``` Fever of Unknown Origin Limp or non-weight bearing Swelling Warmth Erythema ```
63
Presentation of Musculoskeletal Infections in Older Children & Adolescents
Constant localized pain | Fever
64
Diagnosis of Pediatric Musculoskeletal Infections
Blood cultures US: hips MRI with gadolinium
65
Treatment of Pediatric Musculoskeletal Infections
Antibiotics (4-6 weeks) | Decompression & drainage of infected area
66
Antibiotics Need to Cover What Organisms
Staph | Group B strep
67
Treatment of Chronic Osteomyelitis
I&D | Antibiotics: 6-12 months
68
Most Common Organisms for Pediatric Septic Arthritis
S. aureus Group B strep (neonates) Gram negative bacilli (neonates)
69
Presentation of Pediatric Septic Arthritis
``` Fever Edema Erythema Effusion Refusal to ambulate Pseudo paralysis After 72 hours of infection ```
70
Presentation of a Pediatric Septic Hip Arthritis
Flexed Abducted External rotation Severe pain with PROM & rotation
71
Diagnosis of a Pediatric Septic Hip Arthritis
Infectious blood work Plain films: r/o other diagnoses Hip aspiration (gold standard-impractical) Hip US: sagging rope sign
72
Treatment of Pediatric Septic Arthritis
Antibiotics: 3+ weeks | Drainage of joint
73
Possible Sequelae of Pediatric Septic Arthritis
Potential growth plate disturbances
74
Most Common Organisms in Periprosthetic Infections
S. aureus | S. epidermadis
75
How to periprosthetic infections occur?
Direct contact in surgery After surgery (draining incision) Hematogenous inoculation
76
Symptoms of Periprosthetic Infections
Pain not changed by activity levels Stiffness Chronic drainage
77
Diagnosis of Periprosthetic Infections
``` Symptoms Infectious labs Aspiration Plain radiographs (late finding) Bone scan: "hot spot" Indium-111 nuclear scan ```
78
Short Term Periprosthetic Infections
Less than 4-6 weeks post surgery | Hematogenous spread
79
Long Term Periprosthetic Infections
>4-6 weeks after surgery No inciting event Chronic pain
80
Treatment Options for Periprosthetic Infections
``` Antibiotics alone Single stage revision 2 stage revision Amputation Fusion ```
81
Single Stage Revision for Periprosthetic Infections
Short term infections Surgical debridement Antibiotics 6 weeks (2 drugs) Single oral therapy for at least 1 year
82
Two Stage Revision for Periprosthetic Infections
``` Long term infections Surgical debridement Antibiotic cement spacer Antibiotics 6 weeks Antibiotic holiday (2 weeks) Infectious blood work "Normal" blood work- revision arthroplasty Abnormal blood work- start over with surgical debridement Year of antibiotics ```
83
Indications for Amputations in Periprosthetic Infections
Life-threatening sepsis Multiple failed revisions Persistent severe pian
84
Indications for Fusion in Periprosthetic Infections
``` Total knee arthroplasty High functioning patients Single joint Young patient Loss of extensor mechanism ```
85
Prevention of Periprosthetic Infections
Antibiotic prophylaxis for invasive procedures for life | Antibiotics: amoxicillin, cephalosporin, or clindamycin

Ortho (22 decks)

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